急性颈椎脊髓损伤肺部感染特点及早期救治  

Clinical characteristics and early effective treatment for pulmonary infection after acute cervicalspinal cord injury

作　　者：徐广辉[1] 张咏[1] 满毅[1] 贾连顺[2] 

机构地区：[1]上海长征医院闸北分院骨科,200070 [2]上海长征医院骨科

出　　处：《中华医学杂志》2013年第5期352-356,共5页National Medical Journal of China

摘　　要：目的探讨急颈椎脊髓损伤肺部感染特点及其早期有效治疗措施。方法回顾性分析2004年7月至2011年9月收治的215例急性颈椎脊髓损伤患者，分析患者胸片、血常规、电解质、血气分析结果及体温变化，痰培养结果，患者人院即以四代头孢抗感染、其后根据患者痰培养及药敏实验结果调整抗菌素，患者人院后根据患者呼吸模式、血气分析指标判断是否进行气管切开及呼吸机辅助呼吸，每4h进行1次雾化吸入化痰及静脉药物化痰，加强翻身拍背及吸痰，必要时以支气管镜进行吸痰保持呼吸道通畅、每周进行二次床边胸片检查，分析患者肺部感染特点，调整有效抗菌素，出现真菌感染加用抗真菌药物，同时加强静脉3L袋及胃管鼻饲肠内营养，尽早进行脱机及拔除气管插管。结果214例患者最终肺部感染治愈、其中43例继发肺不张，最终1例死亡。患者入院时即出现肺部感染且多伴有高热，血培养结果以铜绿假单胞菌为主，痰培养结果以革兰阳性菌如金黄色葡萄球菌为主，其后以鲍曼不动杆菌等革兰阴性菌等院内感染为主，大部分出现于入院后2周，3-4周后患者多出现继发真菌感染，17例出现条件致病菌肺炎克雷伯杆菌感染，其中1例死亡。结论急性颈椎脊髓损伤肺部感染出现早、感染严重，根据痰培养结果调整有效抗菌素，翻身拍背咳痰训练，加强全身性营养是有效的治疗措施。Objective To explore the clinical characteristics and early effective treatment for pulmonary infection after acute cervical spinal cord injury. Methods A total of 215 inpatients with acute cervical spinal cord injury were retrospectively analyzed. Their chest radiological films and blood profiles at discharge were analyzed. The fourth generation cephalosporin was used to treat pulmonary infection as soon as admission and the antibiotics switched according to the results of sputum culture and drug sensitive test. Incision of trachea was performed and breath supported by breath machine according to respiratory condition and blood gas analysis. All patients were turned over and slapped on the back in order to excrete phlegm in time. Sometimes bronchial lavage was used to excrete phlegm. The chest radiological examinations and sputum culture were performed twice one week. Once fungal infection was definite, specific antibiotic was used to treat infection. Three-liter bus and nasaf feeding were used to improve the nutrition condition. Incision of trachea was closed as soon as possible. Results Pulmonary infection of 214 patients was finally cured. Among them, 43 suffered from pulmonary closure. One patient died from severe infection of Klebsiella pneumoniae. Pulmonary infection appeared upon admission and was mostly accompanied with hyperpyrexia. The result of sputum culture revealed baumanii and the pathogen of hemocuhure was Pseudomonas aeruginosa. At 3 -4 weeks later, mycotic infection appeared. And 17 patients suffered from Klebsiella pneumoniae and one died. Conclusion Pulmonary infection after acute cervical spinal cord injury is severe and occurs early. Effective antibiotics according to the result of sputum culture, turnover ＆ back-slapping for excreting phlegm in time, expectoration training and strengthening overall nutrition are effective therapeutic measures.

关 键 词：脊髓损伤 颈 感染 肺 

分 类 号：R651.2[医药卫生—外科学]